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FOR OFFICE USE: Ie-V .....0 APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No, .7..... ... � This Permit Expires 1 Year From Date Issued Date Issued ...... ...... ...:.. Application is hereby made to the San Joaquin Local Health District for a permit to.construct and install the work herein described. This appy op�ade In m n 1 A County Ordinance No. 549 and existing Rules and Regulations: a yj �J JOB ADDRESS/LOC I N / x� /!- 1, .�p...,c --.........CENSUS TRACT ........ , Owner's Name .. .. ....... :.. . ..... .. rvi e T,yl f �� ------•-,....... . ... �� _. Phone 2 r Address _. ,�f..�..... F. 1 _ _.._..._S1.� ...._------�s_.�.✓._�/f�.. qty _ .:� � 'f,t .:.. Contractor's Name ....._ .�..................................License #,:� /-,g.,3I... Phone Installation will serve: Residence;gApartment House[] Commercial ❑Trailer Court 0 Motel ❑Other -------------------------------------------- Number of living units:... ----- Number of bedrooms .i.�.........Garbage Grinder/k.:�k.__ Lot Size .._......... ......... a _ i Water Supply: 'Public System and name ------------------ ...............-................................................. .....................Private Character of soil to a depth of 3 feet: Sand IX .Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------f yes,type ---..............•---------- 4 (plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse sl e.) F NEW INSTALLATION: ( No septic tank or seepage pit permitted If public sewer'is available within 200 feet,) E � .�� --••• ... Liquid Depth - PACKAGE TREATMENT SEPTIC TANK� Siae. �..._.. - - ------------------- - Capacity/1ZA0-_-_-_- Type �'_Materiaig! l"V.._._... No. Compartments 2"................ Distance to nearest: Well _. ' :.....................Foundation,��......... Prop. Line Zi--------------- LEACHING LINE fj(J f' No. of Lines ..�................ Length of each line,..., �_._._....... Total length ��_`.... kP + .......... 'I, f D' Box 1,L�J�'.. Type Filter Material� . �Depth Filter Material ` _..._... Distance to riearsst: Well �aJ.�.._._..... Foundation ��'_'___.._--.-- Property Line .P.f......... 4� A SEEPAGE PIT [') Depth ...-- .............. Diameter ................ Number ........................... Rock Filled Yes ❑ No ❑ ' Water Table-Depth ----••---•----•.......................•-----•--.Rock Size ................................ Distance jo,nearest: Well ........................................Foundation _.._..._.._...____ Prop. Line ..................... i REPAIR/ADDITION{Prey. Sanitation'Permit+# ...........................-.. ...---------- Date ---•--••---- ) •---•-----------•---• a SepticTank (Specify Requirements) ................... ................•....................................--•.................................------............ Disposal Field (Specify Requirementsl ..............:...................................................................................,........................... .._.__. -----------•-- ----------------------------------------.. ------------ ••.................... . -------•--•----•-----........•----•. ....... ........................................................................ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District, Home owner or iicen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California," # Signed -------------•-?rrthan'ownerl --- -------------... •-----• --------------....._.....--- Owner ! y By ........... .......... ............._.......................... . , ......_._.. {if . ' FOR DEPARTMENTUSE ONLY APPLICATION ACCEPTED BY -- ---------------- .................:.......................... DATE ... BUILDING PERMIT ISSUED .......:............ ..............DATE ADDITIONAL COMMENTS ...................•----._--.------•-------------••--------•-•---- I ...............•- :.. ........................................... ................... -----------------------------------. ---............................. Final Inspection by: L .................... ........Date ... i w SAN JOAQUIN LOCAL' HEALTH DISTRI